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www.jdt.tums.ac.irSeptember 2013; Vol . 10, No. 5 1

Original Article

Evaluation of the Association Between Periodontal

Parameters, Osteoporosis and Osteopenia in Post

Menopausal Women

Amir Moeintaghavi1, Monireh Pourjavad2, Sepideh Dadgar3, Najmeh Shayesteh Tabbakh4

1Department of Periodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran2Department of Gynecology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran3Post Graduate Student, Department of Orthodontics, Dental Faculty, Islamic Azad University Khorasgan (Isfahan) Branch, Kho-rasgan, Iran4Bs, Midwife, Mashhad, Iran

Corresponding author:

S. Dadgar, Department of Or-thodontics, Dental Faculty,

Islamic Azad University Kho-

rasgan (Isfahan) Branch, Isfa-han, Iran

[email protected]

Received: 14 March 2013

Accepted: 2 August 2013

AbstractObjective:Different studies have reported contradictory results about the effect of os-teoporosis on periodontal status. We performed this study to evaluate the periodontalstatus of menopausal women by methods with enough accuracy and confidence.Materials and Methods: This study was performed based on the evaluation of bonemineral density using dual energy X-ray absorptiometry in 2010. A total of 60 pa-tients who met the inclusion criteria were selected and divided into three groups of os-teoporosis, osteopenia, and normal. Then, evaluation of periodontal markers such as

pocket depth (DP), attachment loss (AL), and tooth loss (TL) was performed by adental student. A panoramic radiography was performed for those who were suspi-cious of periodontal disease and bone decline. Finally, evaluation of the periodontalindexes was compared among the three groups using ANOVA with 95% confidenceinterval.Results: Mean bone decline was higher in the osteoporosis group compared to theother two groups, but the difference was not significant (P=0.065). In addition, meanof plaque index (P=0.123), pocket depth (P=0.856), attachment loss (p=0.525), andtooth loss (p=0.884), the number of people with attachment loss 2millimeter(P=0.866) and the number of people with alveolar bone loss 2 millimeter (P=0.348)were not significantly different between the three groups.Conclusion: In this study, no significant difference was observed between the threegroups in terms of plaque index, pocket depth, attachment loss, or tooth loss. Howev-

er, further studies are required that could control all the possible confounding va-riables.

Key Words: Osteoporosis; Bone Demineralization, Pathologic; Periodontitis; Meno-pauseJour nal of Dentistry, Tehran Uni versity of Medical Sciences, Tehran, I ran (2013; Vol. 10, No.5)

INTRODUCTION

Iran has experienced exceptional demographic

changes in the past few decades [1] that has

resulted in an increase in the life expectancy to

about 70.5-75.6 years depending on the geo-

graphical region [2]. In addition, the number

of adults over the age of 64 has increased from

1.2 million in 1976 (3.7% of the population) to

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Journal of Dentistry, Tehran Uni versity of Medical Sciences Moein taghavi et. al

www.jdt.tums.ac.irSeptember 2013; Vol . 10, No. 52

3.5 million in 2006 (5.5% of the population)

[1]. As a result, the incidence of age-related

diastases has significantly increased.

Menopause is a physiological event that oc-

curs approximately at the age of 50 due to in-

terruption in the menstrual cycle and results inirreversible hormonal changes [3]. Osteoporo-

sis is a skeletal disorder characterized by sig-

nificant reduction in bone mineral density

(BMD) or too little bone in the bone, which

increases the risk of bone fracture. Osteoporo-

sis is the most common metabolic bone dis-

order that results in a major public health is-

sue. The incidence of osteoporosis is increas-

ing as the world moves towards a more aging

population [4-6]. According to a study con-

ducted by Maddah et al. [7] in Iran the preva-

lence of osteoporosis is higher in postmeno-

pausal women.

Periodontitis is a destructive inflammatory

disease of the supporting tissue of the teeth,

characterized by loss of connective tissue and

alveolar bone. Like osteoporosis, periodontitis

is a silent disease, which does not cause any

sign or symptom until late stages of the dis-

ease that is revealed by mobile teeth, ab-

scesses or tooth loss [8, 9].Periodontitis causes tooth loss [10] similar to

osteopenia and osteoporosis that in severe cas-

es is related to alveolar bone and tooth loss in

women after menopause [11, 12]. A number

of cross sectional studies have looked at the

relationship between bone mineral density

(BMD) of postmenopausal women and tooth

loss. However, only a few studies reported sta-

tistically significant correlation between re-

duced BMD at varying sites and tooth loss

[13].Krall et al. found that only tooth count and

lumbar bone mineral density are significantly

correlated [14]. Significant association be-

tween femoral neck bone mineral density and

tooth loss was reported in another study [15];

however, in the aforementioned study, the cor-

relation between the spinal bone mineral den-

sity and tooth loss was not significant.

On the other hand, specific Interleukin-1 gene

polymorphisms, as an important mediator of

inflammation and bone destruction in the peri-

odontium, and vitamin D gene have been iden-

tified as a receptor [16]. This study was con-

ducted to evaluate the potential associationbetween osteoporosis and periodontal indices

such as plaque index (PI), pocket depth (PD),

attachment loss (AL), alveolar bone loss (BL)

and number of tooth loss (TL) among postme-

nopausal Iranian women in order to clarify

some of the existing controversies.

MATHERIALS AND METHODSTwenty subjects were selected per group

based on the results of the study by Khorsand

et al. [18] using the following formulation:

n =S1

2 +S22(

12

+1 )2

(x1x2)2

n =6/42+4/52(1/96+0/84)2

(7/2512/25)220

Therefore, in the current cross-sectional study,

60 postmenopausal women above the age of

50 (51-75 years old; mean age, 521.72) were

admitted to the densitometry clinic at Mash-had University of Medical Sciences, Imam

Reza Hospital. Menopause is referred to a

stage in life, where the subject will no longer

experience menstrual flow, and in this study

we considered 12 consecutive months with no

menstrual flow as menopause. Postmenopaus-

al women with at least 10 natural teeth except

for 3rd molars were included. All the ap-

proved subjects signed a consent form before

being enrolled in the study.

The selection criteria excluded subjects requir-

ing antibiotic prophylaxis; those with parathy-

roid and metabolic bone diseases, diabetes, a

positive history of immunosuppressive thera-

py; and addiction. All the participants had fol-

lowed the oral hygiene measures, evaluated by

twice brushing per day in the past 2 years.

BMDs of the lumbar spine and right femoral

neck were measured using the dual-energy X-

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Moein taghavi et. al Evaluation of the Associati on Between Periodontal Parameters

www.jdt.tums.ac.irSeptember 2013; Vol. 10, No. 5 3

ray absorptiometry method (DEXA) by a

trained X-ray technician. This method allowed

us to classify the subjects to osteoporosis, os-

teopenia or normal bone density based on site-

and gender-specific cut-off values of the stan-dard deviations (T-scores) compared to a ref-

erence group of young normal adults. A T-

score below -2.5 was considered as osteoporo-

sis; between -1.5 and -2.5 was classified as

osteopenia; between -1.5 and -1 was classified

as mild osteopenia and a T-score over -1 was

considered as normal [17]. The same endocri-

nologist conducted the exclusion process and

the study subjects were selected among the

people whose osteoporosis was due to their

menopause. The study population was equallydivided into three groups: osteoporosis, osteo-

penia and normal groups.

Periodontal examinations were performed on

all teeth except for the 3rd molars by a blind

examiner and consisted of: 1) plaque index

(PI), 2) pocket depth (PD), 3) attachment loss

(AL) 4) alveolar bone loss (BL), and 5) num-

ber of tooth lost (TL). PI was assessed based

on OLeary index. A dental mirror, an explor-

er and a Williams periodontal probe were used

for clinical evaluation.

Alveolar BL was evaluated using panoramic

radiography; we measured the distance be-

tween the CEJ and alveolar crest using a digi-

tal caliper in mm. All of the periodontal para-

meters were evaluated for all subjects (n=60).

Statistical Analysis

Statistical analysis was performed using SPSS

for Windows version 11.5 (SPSS Inc., Chica-

go, Illinois, USA)). Descriptive statistics in-

cluding means, standard deviations, ranges,

and percentages were calculated for all va-

riables (PI, PD, AL, BL and TL) between the

three subject groups. .ANOVA or Kruskal

Wallis tests were used to compare variables

between the groups. A p-value less than 0.05was considered significant.

RESULTS

Twenty patients were selected in each group:

osteoporosis (mean age 56), osteopenia (mean

age 52.31) and normal (mean age 50.85)

groups. There were no significant differences

between the groups according age (P=0.065).

The differences between T scores in three

groups were statistically significant (P=0.000)

(Table 1).

Groups N

Tscore

MeanStd. Deviation Std. Error

95% Confidence In-

terval for MeanMinimum Maximum

Lower

BoundUpper Bound

Osteoporosis 20 -3.1105 .49314 .11313 -3.3482 -2.8728 -4.20 -2.27

Osteopenia 20 -1.4053 .54189 .12432 -1.6664 -1.1441 -2.40 -.10

Normal 20 .6495 1.16897 .24922 .1313 1.1678 -.60 3.80

Total 60 -1.1918 1.76484 .22784 -1.6477 -.7359 -4.20 3.80

Table 1.T Scores in Different Groups

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No significant difference was observed in al-

veolar bone loss between the osteoporosis, os-

teopenia and normal groups (P = 0.06;

F=2.89). However, patients with osteoporosis

had higher percentages of alveolar bone loss

compared to the osteopenic and normal indi-viduals. The plaque index in osteoporotic

women was higher than the other two groups,

but this difference was not statistically signifi-

cant (P=0.12; F=2.17). In the present study,

there were no significant differences in the

other recorded periodontal parameters such as

pocket depth, attachment loss and number of

tooth loss between the three groups (P


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Moein taghavi et. al Evaluation of the Associati on Between Periodontal Parameters

www.jdt.tums.ac.irSeptember 2013; Vol. 10, No. 5 5

Lundstrm et al. [20] did not show any signif-

icant difference in periodontal conditions or

marginal bone level between the osteoporotic

and control group. It seems that osteoporosis

does not increase the incidence of periodontaldiseases perhaps due to its effect on bone

quality rather than the quantity. On the con-

trary, Payne et al. [21] reported that osteopo-

rosis/osteopenia and estrogen deficiency are

risk factors for alveolar bone density loss in

postmenopausal women with a history of peri-

odontitis.

The aforementioned study was a 2-year longi-

tudinal clinical study, where the alveolar bone

height and density changes were compared

between two groups of women with osteopo-rosis/osteopenia and normal lumbar spine

bone mineral density (BMD). In addition, Sul-

tan and Rao [22] reported that skeletal BMD is

related to interproximal alveolar bone loss and

clinical attachment loss, though not to a statis-

tically significant level; implicating postme-

nopausal osteopenia as a risk indicator for pe-

riodontal disease.

The controversies observed between the re-

sults of the present study and other studies

may be due to limitations such as the cross

sectional nature of the current study, small

sample size or lack of controlling confounding

factors.

CONCLUSION

In conclusion, within the limitations of the

present study, changes in examined periodon-

tal indices such as plaque index, pocket depth,

alveolar bone loss, attachment loss and num-

ber of tooth loss were not associated withBMD changes in Iranian postmenopausal

women. Further longitudinal studies with larg-

er sample size might be necessary to substan-

tiate our findings.

REFERENCES1-

Sarraf-Zadegan N, Boshtam M, MalekafzaliH, Bashardoost N, Sayed-Tabatabaei FA,Rafiei M et al. Secular trends in

cardiovascular mortality in Iran, with specialreference to Isfahan. Acta Cardiol. 1999Dec;54(6):327-33.2-Farzadfar F, Danaei G, Namdaritabar H,Rajaratnam JK, Marcus JR, Khosravi A et al.

National and subnational mortality effects ofmetabolic risk factors and smoking in Iran: acomparative risk assessment. Popul HealthMetr. 2011 Oct 11;9(1):55-66.3-Soules MR, Sherman S, Parrott E, Rebar R,Santoro N, Utian W et al. Executive summary:Stages of Reproductive Aging Workshop(STRAW). Climacteric. 2001 Dec;4(4):267-72.4-Nordin BE. Redefining osteoporosis. CalcifTissue Int. 2008 Dec;83(6):365-7.5-Krejci CB. Osteoporosis and periodontaldisease: is there a relationship? J West SocPeriodontol Periodontal Abstr. 1996;44(2):37-42.6-

NIH Consensus Development Panel onOsteoporosis, and Therapy. Osteoporosis

prevention, diagnosis, and therapy. JAMA.200 Feb 14;285(6):785-95.7-Maddah M, Sharami SH, Karandish M.Educational difference in the prevalence ofosteoporosis in postmenopausal women: astudy in northern Iran. BMC Public Health.2011 Nov 3;11:845-8.8-Papapanou PN. Epidemiology of

periodontal disease: an update. J Int AcadPeriodontol. 1999 Oct;1(4):110-6.9-

Burt B; Research, Science and TherapyCommittee of the American Academy ofPeriodontology. Position paper: epidemiologyof periodontal diseases. J Periodontol. 2005Aug;76(8):1406-19.10-Mohammad AR, Jones JD, BrunsvoldMA. Osteoporosis and periodontal disease: areview. J Calif Dent Assoc. 1994Mar;22(3):69-75.11-Wactawski-Wende J, Grossi SG, Trevisan

M, Genco RJ, Tezal M, Dunford RG et al. Therole of osteopenia in oral bone loss andperiodontal disease. J Periodontol. 1996Oct;67(10 Suppl):1076-84. Review.12-

Birkenfeld L, Yemini M, Kase NG, Bir-kenfeld A. Menopause- related oral alveolar

bone resorption: a review of relatively unex-plored consequences of estrogen deficiency.Menopause. 1999 Summer;6(2):129-33.13-Megson E, Kapellas K, Bartold PM.Relationship between periodontal disease and

447


6/7



osteoporosis. Int J Evid Based Healthc. 2010Sep;8(3):129-39.14-Krall EA, Dawson-Hughes B, Papas A,Garcia RI. Tooth loss and skeletal bonedensity in healthy postmenopausal women.Osteoporos Int. 1994 Mar;4(2):104-9.

15-

Taguchi A, Fujiwara S, Masunari N,Suzuki G. Self-reported number of remainingteeth is associated with bone mineral densityof the femoral neck, but not of the spine, inJapanese men and women. Osteoporos Int.2004 Oct;15(10):842-6.16-Inagaki K, Krall EA, Fleet JC, Garcia RI.Vitamin D receptor alleles, periodontal disease

progression, and tooth loss in the VA dentallongitudinal study. J Periodontol. 2003Feb;74(2):161-7.17-Kanis JA. Assessment of fracture risk and

its application to screening forpostmenopausal osteoporosis: synopsis of aWHO report. WHO Study Group.Osteoporosis Int. 1994 Nov;4(6):368-81.18-Khorsand A , Paknejad M , Vakili F.

[Evaluation of periodontal condition ofmenopause women with osteoporosis andosteopenia and comparison with controlgroup] [Article in Persian]. J Dent Med.2006;19(3):76-83.19-Lpez-Marcos JF,Garca-Valle S,Garca-

Iglesias AA. Periodontal aspects in menopaus-al women undergoing hormone replacementtherapy. Med Oral Patol Oral Cir Bucal. 2005Mar-Apr;10(2):132-41.20-

Lundstrm A, Jendle J, Stenstrm B, TossG, Ravald N. Periodontal conditions in 70-year-old women with osteoporosis. Swed DentJ. 2001;25(3):89-96.21-

Payne JB, Reinhardt RA, NummikoskiPV, Patil KD. Longitudinal alveolar bone lossin postmenopausal osteoporotic/osteopenicwomen. Osteoporos Int. 1999;10(1):34-40.

22-

Sultan N, Rao J. Association betweenperiodontal disease and bone mineral densityin postmenopausal women: a cross sectionalstudy. Med Oral Patol Oral Cir Bucal. 2011May 1;16(3):e440-7.

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T e h r a n U n i v e r s i t y o f M e d i c a l S c i e n c e s a n d i t s c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o

m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e c o p y r i g h t h o l d e r ' s e x p r e s s w r i t t e n p e r m i s s i o n .

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